Provider Demographics
NPI:1508961624
Name:KUNKEL, TERRENCE PHILLIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:PHILLIP
Last Name:KUNKEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 10TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-2263
Mailing Address - Country:US
Mailing Address - Phone:815-224-3552
Mailing Address - Fax:815-224-5724
Practice Address - Street 1:1723 10TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-2263
Practice Address - Country:US
Practice Address - Phone:815-224-3552
Practice Address - Fax:815-224-5724
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-183831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice